Doctors question government抯 prediction of an end to premature heart deaths
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《英国医生杂志》
Claims that the NHS in England is "winning the war" against coronary heart disease and that premature deaths resulting from the condition will become "very rare" over the next decade have been criticised as simplistic by experts in the field.
In a four year progress report on the implementation of the national service framework for coronary heart disease, published last week, the national clinical director for heart disease, Dr Roger Boyle, claimed that the "corner had been turned" in preventing and treating coronary heart disease. Results in the report showed that the death rate from heart disease in people under the age of 75 had fallen by almost a quarter since 1996. Graphs extrapolating trends in mortality from coronary hear disease for people under the age of 65 suggested that the death rate due to heart disease in this age group would be very low by 2013. An exponential projection based on the 10 years 1993 to 2002 indicated that the national service framework抯 target of 40% reduction in deaths from circulatory diseases by 2010 would be achieved three years early. Figures showed that in 1995-7, almost 142 people under 75 died from circulatory disease per 100 000 of the population, but the projection predicted that this death rate would have fallen to 85 people per 100 000 by 2005-7.
Epidemiologists and heart experts have suggested, however, that the report failed to take account of the increase in cardiovascular deaths that will be associated with the growing rates of obesity. The projections in the report assumed that death rates due to heart disease would continue to fall as quickly as they had in the past 10 years, argued the director general of the British Heart Foundation, Peter Hollins. He criticised the report for ignoring the "ticking time bombs of obesity and growing inactivity which could halt the decline of heart disease."
Dr Eric Brunner, reader in epidemiology at University College London, described the projections in the report as "somewhat optimistic." He said: "In light of the enormous growth in childhood and adult obesity and the probability that we抮e now getting down to hardcore unreformable smokers, unless public health measures are taken to deal with both these problems it seems unlikely the targets will be met." He suggested that the government should build on the success of its free "school fruit scheme" and NHS smoking cessation clinics by banning the advertising of junk food to children and banning smoking in the workplace. Most of the government抯 efforts have focused on better treatments for people with heart disease, rather than preventive measures, he concluded.(London Katherine Burke)
In a four year progress report on the implementation of the national service framework for coronary heart disease, published last week, the national clinical director for heart disease, Dr Roger Boyle, claimed that the "corner had been turned" in preventing and treating coronary heart disease. Results in the report showed that the death rate from heart disease in people under the age of 75 had fallen by almost a quarter since 1996. Graphs extrapolating trends in mortality from coronary hear disease for people under the age of 65 suggested that the death rate due to heart disease in this age group would be very low by 2013. An exponential projection based on the 10 years 1993 to 2002 indicated that the national service framework抯 target of 40% reduction in deaths from circulatory diseases by 2010 would be achieved three years early. Figures showed that in 1995-7, almost 142 people under 75 died from circulatory disease per 100 000 of the population, but the projection predicted that this death rate would have fallen to 85 people per 100 000 by 2005-7.
Epidemiologists and heart experts have suggested, however, that the report failed to take account of the increase in cardiovascular deaths that will be associated with the growing rates of obesity. The projections in the report assumed that death rates due to heart disease would continue to fall as quickly as they had in the past 10 years, argued the director general of the British Heart Foundation, Peter Hollins. He criticised the report for ignoring the "ticking time bombs of obesity and growing inactivity which could halt the decline of heart disease."
Dr Eric Brunner, reader in epidemiology at University College London, described the projections in the report as "somewhat optimistic." He said: "In light of the enormous growth in childhood and adult obesity and the probability that we抮e now getting down to hardcore unreformable smokers, unless public health measures are taken to deal with both these problems it seems unlikely the targets will be met." He suggested that the government should build on the success of its free "school fruit scheme" and NHS smoking cessation clinics by banning the advertising of junk food to children and banning smoking in the workplace. Most of the government抯 efforts have focused on better treatments for people with heart disease, rather than preventive measures, he concluded.(London Katherine Burke)